Provider Demographics
NPI:1720567811
Name:GARVEN, EILISH
Entity Type:Individual
Prefix:
First Name:EILISH
Middle Name:
Last Name:GARVEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1227 ANSEL RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44108-3323
Mailing Address - Country:US
Mailing Address - Phone:164-210-0662
Mailing Address - Fax:
Practice Address - Street 1:1227 ANSEL RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44108-3323
Practice Address - Country:US
Practice Address - Phone:216-421-0662
Practice Address - Fax:216-521-6006
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.1902174101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)